Q: I'm a fairly active person, plus I'm a bit of klutz, so I'm
no stranger to bumps and bruises. But now, I'm noticing black and blue
marks on my arms and legs where I don't remember injuring myself. I take
a multivitamin, so I figure it's not anemia. What else could it be?

Dr. Donnica: Unexplained bruising is very common in women. As you suspected,
the most common causes are bumping into things without realizing it. Some people
are more susceptible to bumps and some people bruise more easily than others.
Bruises can easily occur in those who exercise rigorously, resulting from microscopic
tears in blood vessels under the skin. Bruises may also occur, or appear, more
frequently in thinner people, because there isn't as much fat to cushion
against injury and a bruise is more likely to be apparent. Bruises will also occur
and appear more frequently in older people, because our skin thins as we age and
the tissues that support the underlying blood vessels become increasingly fragile.
Many medications may also increase the risk of bruising: taking aspirin, ibuprofen
or other non-steroidal anti-inflammatory drugs; anticoagulants; or even birth
control pills may increase bruising.

What we worry about is when unexplained or increased bruising may indicate
a bleeding disorder. Medical conditions such as liver or kidney disease; blood
disorders, such as hemophilia, platelet dysfunction, thrombocytopenia, leukemia,
and multiple myeloma; connective tissue disorders including scurvy, Marfan's
syndrome, and Ehlers-Danlos syndrome may all cause easy bruisability. If you
are also having nosebleeds, longer or heavier periods, or bleeding gums when
you brush your teeth, you should consult your physician.

Most bruises do not require treatment unless they are painful. In most cases,
applying an ice pack or cold compress to the area for 15 minutes two to three
times per day should help. For discomfort, choose acetaminophen rather than
a non-steroidal or aspirin-containing preparation. Call your doctor if a bruise
is accompanied by swelling and extreme pain (especially if you take a blood-thinning
medication). You should contact your physician if a bruise does not improve
within two weeks or fails to completely clear after three or four weeks.

In general, a daily multi-vitamin will not prevent bruises or anemia. Many
physicians recommend increasing dietary Vitamin C or taking vitamin C supplements
to help prevent or diminish bruising in patients with easy bruising, since Vitamin
C plays a major role in strengthening blood vessels. While controlled research
data is limited, doctors often suggest that people with easy bruising supplement
with 100 mg to 3 grams of vitamin C per day for several months. Topical arnica
is also considered by some practitioners to be among the best wound-healing
herbs. Some healthcare practitioners recommend mixing 1 tablespoon of arnica
tincture in 500 ml water, then soaking thin cloth or gauze in the liquid and
applying it to the injured area for at least 15 minutes four to five times per
day. For most bruises, however, this is not necessary.